103 & 204: Cost Control Strategies: Do You Really Know Your Costs? Part 1

Transcription

1 103 & 204: Cost Control Strategies: Do You Really Know Your Costs? Part 1 David Berman, CPA, CVA, Principal Simione Healthcare Consultants Andrea Devoti, MSN, MBA, CHCE, President & CEO of Neighborhood Health Agencies Rob Simione, BS, CPA, Vice President of Simione Financial Monitor Walter Borginis, CPA, CGMA, MBA, CFO of VNA of Greater Philadelphia Shawn Ricketts, CPA, CFO Heritage Home Healthcare and Hospice Objectives Identify direct and indirect costs and understand the relationship of costs to multiple reimbursement models. Gain a better understanding of non clinical and back office costs and become able to evaluate operational cost structure compared to industry benchmarks. Utilize industry benchmarks to evaluate the operating costs and revenue. Create buy in from staff and management on cost efficiency objectives 1

2 Introduction Cost Management Work Group Cost Management White Paper Task Force Wl Walter Borginis i III, CPA, Chief Editor Joe Calcutt, Chair, Innovations Committee William Dombi, JD, Editor Josh Sullivan, Editor Other Contributors: Jeffrey Aspacher Ramsey Badre SaraniBanerji Mary Bartlett Tom Boyd Melinda Gaboury, COS C Anne Hochsprung Pat Laff, CPA Larry Leahy Bill Musick Mark Sharp, CPA Bob Simone Rob Simione, CPA REGULATORY CHANGES AND SCRUTINY STATE AND FEDERAL AUDITS FACE TO FACE ICD 10 AFFORDABLE CARE ACT ACCOUNTABLE CARE ORGANIZATIONS COLLABORATION BETWEEN POST ACUTE PLAYERS MEDICARE CUTS SEQUESTRATION HOMECARE REBASING HOSPICE PAYMENT REFINEMENT HOSPICE REBASING HOSPICE SITE OF CARE PRODUCTIVITY ADJUSTMENT HOSPITALS & PAYORS PREVENT REHOSPITALIZATIONS POPULATION HEALTH MANAGEMENT RISK BASED PAYMENT BUNDLING DEMONSTRATE VALUE - $ 2

3 This is probably how we all feel 5 We try to save cost but we cant sacrifice our mission! 3

4 Where do I start? All Financial Cost Data should be easily accessible and broken out. General Ledger Payroll Software Identify Critical Financial KPI Indicators Keep it Simple Focus on Revenue & Cost Drivers Automate your reports Excel Reporting software s Outside vendors Compare to Benchmark Data Work as a Team Everyone should be involved Executive Management Clinical Directors Financial Directors Need buy in from everyone when it comes to cost review. Analyze what htwould happen based on industry changes if all cost remained the same. Determine if something must be done! 4

5 Benchmark Comparisons Research benchmark sources available NAHC, NHPCO, OCS, SHP, Financial Monitor, MVI, Cost treport tdt data Understand data elements and calculations Need to ensure apples to apples comparison Who are you comparing to? Geography, Payer Mix, Profit Status, Agency Type, Revenue Size Remember benchmarks are the median Always strive to be in the top 10 to 20% Gross Margin Gross Margin is where you need to start in any financial analysis. Everyone s performance has an affect on Gross Margin. Direct revenue minus direct expenses Direct Revenue All Net Payer Revenue DirectExpenses Salaries, payroll taxes, workers compensation, benefits, contract, mileage and supply costs from direct patient care 5

6 Gross Margin Financial Monitor Data as of June 30th 2014: National Gross Margin 43% Top 20% Gross Margin 52% Gross Margin by Payer 60% 50% 49% 41% 40% 30% 24% 28% 20% 10% 0% Medicare PPS Medicare Advantage Medicaid (any) Other Where to look next? Revenue Admissions Payer Mix Case Weight Mix Costs Payment Models Staffing Productivity Supplies 6

7 Revenue Review Admission Data Hold staff accountable to admission s not referrals By Referral Source By Payer Source Remember not all admissions are created equal Review Case Weight Mix Accuracy of Oasis Therapy Utilization Payer Mix 7

8 Costs Review your payment models Pay Per Visit Sl Salary Hourly Contract Services Productivity Visits per day Tl Telemonitoring i Benefit Plans Supply and Mileage Costs Caution Cutting direct staff salary and benefits can result in: High employee turnover Cutting corners in patient care Overworked staff All will have a negative impact on productivity All will have a negative impact on productivity and quality 8

9 Direct Cost Per Visit Home Health Discipline National Skilled Nursing $93 Physical Therapy $94 Occupational Therapy $97 Speech Therapy $111 Medical Social Worker $133 Home Health Aide $40 Supplies $2.65 Distribution of Direct Costs Discipline National Skilled Nursing 50% Physical Therapy 34% Occupational Therapy 9% Speech Therapy 2% Medical Social Worker 1% Home Health Aide 4% 9

10 Direct Cost Distribution Discipline Salaries Taxes & Benefits Contract Services Transportation Supplies Total 70% 17% 5% 5% 3% Direct Cost Distribution Discipline Salaries Taxes & Benefits Contract Services Transportation SN 75% 18% 2% 5% PT 68% 16% 11% 5% OT 69% 16% 10% 5% ST 68% 16% 11% 5% MSW 69% 17% 8% 6% HHA 61% 15% 11% 13% 10

11 Discipline Productivity Home Health Visits Per Day National Skilled Nursing 4.4 Physical Therapy 5.7 Occupational Therapy 5.7 Speech Therapy 4.7 Medical Social Worker 2.4 Home Health Aide 4.3 Visits by Payer Discipline Medicare Medicare Advantage Medicaid Other Nursing Therapy Medical Social Worker Home Health Aide

12 Productivity Is there enough support to facilitate productivity? Do the teams have adequate clerical support to minimize clinician i i time spent on non clinical i l tasks? k? Are clinical support resources available to assist the team with problems in the field? Do clinicians have reliable communication tools such as cell phones, pagers, or ? Do you use telehealth? Are there other technologies available to increase productivity? Are clinicians properly utilizing technology during the visit? Is documentation done in the patient s home or at the clinicians home? Productivity What are the barriers to meeting productivity? it Average miles per visit Time available to visit Patient acuity Supply ordering Software or hardware issues Duplication of paperwork 12

13 Productivity What are the pitfalls of increasing productivity? Incentives which reward the number of visits without considering outcomes Cutting corners on patient care Increased need for care Readmissions to home care Re hospitalizations Emergency room visits Impact on patient or consumer satisfaction Non Employee Costs Medical Supplies Send out an RFP to determine if you are getting the best deal Review your formularies Look at transportation costs Are you reimbursing at the IRS allowable or less than that? Do you have an automated way of tracking mileage for accurate recording? Do you randomly audit mileage? Will leasing cars result in lower costs? 13

14 How to identify areas of improvement Need information to make sound business decisions Information should be simple and easy to understand Detail analysis is for the finance department Information should be product line specific Home Health Hospice Private Duty Etc Who are the Stakeholders Each Stakeholder requires a different level of analysis Board of Directors/Owners Senior Management Managers All Employees 14

15 Who are the Stakeholders Board of Directors/Owners Financial Statements, Key Indicators Should understand the plan and responsible for reviewing the outcomes Senior Management Financial Statements, Key Indictors, details behind key stats Responsible for establishing a plan and prioritization Who are the Stakeholders Managers Financial overview, key statistics Must understand the Why Key to making the plan successful All Employees Financial and key statistic overview Need to understand where the organization is Should be educated in issues related to te industry 15

16 Strategies to Make Change Information needs to be analyzed in a meaningful way Step one: Overall Income Statement broken down between gross and net margin Salaries/Taxes/Benefits for direct care Staff Contracted services for direct care Workers Comp Medical Supplies/Drugs/DME Travel for direct care staff Strategies to Make Change Step two: Income statement (gross vs. net margin) by service line Home Health Hospice Private Duty Etc Step three: Key Indictors by service line 16

17 Strategies to Make Change If information isn t analyzed by service line, a thriving i service may hide a weakness or inefficiency in another Strategies to Make Change Gross Margin Data looked at monthly, year to date, trailing twelve months and always compared to the prior period Internal and external benchmarks should be used to evaluate to results Includes budgets 17

18 Strategies to Make Change Gross Margin Revenue Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TTM Direct Expenses: Salaries Payroll Taxes and Benefits Worker's Comp Contracted Services Medical Supplies Travel Total Direct Expense % of revenue Gross Margin % of revenue Strategies to Make Change Gross Margin What do you notice about gross margin? As there continues to be rate pressure margins will decline if we operate as we always have Look at the correlation of revenue to gross payroll Gross payroll/revenue Is the percentage increasing? 18

19 Strategies to Make Change Gross Margin We saw in increasing percentage so what did we do? Case Weight (traditional and fully loaded ) Adjustments Productivity Benefits Scheduling Strategies to Make Change Gross Margin Case Mix Weight Always start with the basics Fully Loaded = net reimbursement/episodes ended If fully loaded decreasing move on to adjustments by type Be careful of the ripple effect of adjustments 19

20 Strategies to Make Change Gross Margin Productivity Once revenue en e is addressed time to look at expenses Don t be afraid of the productivity issue Common Pitfalls Not getting buy in from managers Allowing the staff to dictate the weighting (if you chose to weight) Not being consistent in monitoring Ignoring caseloads Strategies to Make Change Gross Margin Productivity-The Calculation Visits/(hours worked/8) Assuming 8 hour days Excludes vacation, sick and PTO time Includes Overtime Assumes no weighting 20

21 Strategies to Make Change Gross Margin Full Time Week 1 Week 2 Week 3 Week 4 A B C D E F G H I J Total Strategies to Make Change Gross Margin What does it cost? Under productive Visits Employee Week 1 Week 2 Week 3 Week 4 A B C D E F G H I J Total

22 Strategies to Make Change Gross Margin What does it cost? Employee Week k1 Week k2 Week k3 Week k4 Annualized A $ 882 $ 840 $ 756 $ 756 $ 38,808 B ,648 C ,704 D 1, ,392 E 672 1,050 1, ,792 F 546 1, ,800 G ,664 H 1,512 1,470 1,386 1,218 67,032 I ,728 J 966 1,596 1,176 1,218 59,472 Total $ 8,694 $ 8,694 $ 7,980 $ 6,552 $ 383,040 *assumes $42/visit **assumes 48 weeks available to work Strategies to Make Change Gross Margin Productivity Roadblocks No accounting for overtime The what if factor Managers not sending the correct message No enforcement of the standard 22

23 Strategies to Make Change Gross Margin Scheduling Effects both productivity and mileage expense Do you automate your scheduling? Does the driving pattern make sense? What is the ROI on leasing cars vs. paying mileage in the most efficient scheduling model? Review Strategies to Make Change Gross Margin Revenue Case mix weight/adjustments Direct Payroll Productivity/Overtime/Caseloads Payroll Taxes and Benefits Retirement plans/health insurance increase Travel Scheduling/lease vs. pay mileage 23

24 Productivity Goals RN: 4-5 LPN: 5-6 PT: 5-6 PTA: 5-6 How to get staff/managers to buy in Tough sell Variable factors Travel, due to geography Time Distance Weather and other unpredictable variables 24

25 Weighting of Visits Big discussion Use whatever method makes the biggest impact with managers Not all visits the same Not all territories equal Use of Point of Care in the Home May not be able to complete all documentation ti Increases accuracy Facilitates comprehensive teamwork Use of telehealth 25

26 How to Engage Staff Explain rationale for making productivity One to one conversations with those less productive Allow for variability when precepting new staff or other special projects Send Out With IT Trainer Do admission visit Demonstrate ability to streamline Tips and timesavers Reinforce non-threatening nature of this visit, but ramifications of noncompliance 26

27 Managerial Oversight of Staff Per payroll monitoring Overtime vs. productivity and costs Then average per person per month Geographic Distribution Are expectations realistic? Knowing territory Mileage vs. productivity vs. overtime Driving all over vs. limited area Are staff able to transfer while on the road to Are staff able to transfer while on the road to upload and download new information what technology do they have to use, and what is the wireless coverage in your area? 27

28 Look at Acuity of Patient Multiple wounds Multiple medications Social issues After Visit? Is employee counting charting/phone time in total t patient t care time? When is that charting being done? 28

29 Staff Buy-In No recall necessary or extra notebooks Time at home is your time Increase accuracy of documentation Manager Buy-In Happier staff Less work documenting overtime and tracking Better care coordination Increased quality measures 29

30 Use of LPNs, PTAs, OTAs Where appropriate and allowed Supervision time Lets Take a Break! 30

31 103 & 204: Cost Control Strategies: Do You Really Know Your Costs? Part 2 David Berman, CPA, CVA, Principal Simione Healthcare Consultants Andrea Devoti, MSN, MBA, CHCE, President & CEO of Neighborhood Health Agencies Rob Simione, BS, CPA, Vice President of Simione Financial Monitor Walter Borginis, CPA, CGMA, MBA, CFO of VNA of Greater Philadelphia Shawn Ricketts, CPA, CFO Heritage Home Healthcare and Hospice Net Margin Management/Finance Responsibility Are you staffed properly based on projected patient volume and payer mix? Have you reviewed your non employee costs? Are your operations and reporting automated? Where are their strengths and weaknesses with in your documentation and reporting processes? Breaking down you cost by department and type. 31

32 Net Margin Must look at the whole picture when reviewing indirect costs. The cost compared to the benchmark The performance of the department The affect on incoming revenue Staffing of the organization (overworked staff = cash flow and compliance issues) The future of the industry What are partners looking for? What roles/responsibilities will be more on the executive team? What will be centralized? Home Health Net Margin National Freestanding 3.5% National Hospital Based 3.5% Part of Chain (Home Office) 12.3% 32

33 Net Margin Home Health National By Payer: 60% 50% 40% 30% 20% 10% 0% 14% Medicare PPS 4% Medicare Advantage 2% 17% Medicaid (any) Other Back Office Cost When reviewing and benchmarking back office costs remember to consider: Paper vs. Electronic Record Volume of Non Medicare Claims Authorizations/Payer Setup Paper vs. Electronic Submission of Claims Staff Effectiveness Staff Training Effective Reporting Outsourcing options 33

34 Total Indirect Costs Cost as a % of Total Revenue Agencies with no Home Office Costs Total 37% of Revenue Salaries 17% Benefits 4% Other Admin 16% Marketing Costs National 2.16% Top Performers 3.83% Hold Marketers accountable for admission NOT referrals Educate your marketing team on the importance of Medicare admissions compared to Managed Care/Medicaid Review Admissions per Marketing FTE 30 Admission per Month per Marketing FTE 60 Admission per Month per Marketing FTE Best Practice 80% Referral to Admission Conversion Ratio Review your Advertising Campaigns do they generate business? Review any Marketing cuts and their impact on revenue. Who will be your future Marketers CEO, President, Owners. 34

35 Intake Department Benchmark 2.30% Collections start with Intake! Review amount of denied authorization and reauthorizations Authorization per Intake FTE Ensure proper authorization process is in place for non Medicare patients Billing Department Billing Department 1.16% Accounting Department.85% Review days sales outstanding Overall 63 days Best Practice 35 days Review bad debt as a % of revenue (.91%) Review days from SOC to RAP and EOE to final claim Days to RAP 8 Days Best Practice Days to Final 12 Days Best Practice Ensure all claims are sent electronically (non Medicare as well) Evaluate staff do you have the right person for the job? No other task just collections 35

36 Clinical Supervision/Support/QI Benchmark 9.2% of Total Revenue 180 patients per Case Manager 1 Manager to 9 staff nurses 85.7% of agencies use an integrated delivery care team Supervisors must hold clinicians accountable to productivity standards Coordinators must schedule staff to be efficient to achieve productivity measures Support staff must assist with any field issues QI must ensure that clinicians and staff are compliant with all rules and regulations. Outsource coding function? Maximize case weight mix Home Health Information Technology National 1.58% Total IT Cost as a % of Revenue Average Gross Margin 5% or More 31% 2.5% to 5% 39% 1.0 to 2.5% 46% Less than 1% 27% 36

37 Information Technology Educate and train your clinicians and back office staff on how to best use the EMR system to create efficiencies Outsource hardware and server support Research new technology that can improve efficiencies: Patient Portals Telehealth New devices/applications Other Staffing Costs Executive Management 3.30% Medical Records.59% HR/Education/Recruitment 1.02% Development & Fundraising.44% Other Office Support 2.75% Home Office 10.20% (Hospital, Home Office or Management Allocation) 37

38 Non Employee Costs Space Occupancy 1.96% Rent or Own Space? Mobile work staff Utilities & Maintenance Fees Renegotiate interest rates Legal/Audit/Professional Fees.71% Send out an RFP every 2 3 years Outsource cost report function Outsource or in house legal department? Non Employee Costs Liability Insurance.39% Interest Expense.20% Bad Debt.93% Equipment Purchase/Lease/Repairs.40% All Other Admin 2.4% 38

39 Employee Health Insurance Ask the broker to review costs of various plan designs and insurance companies in order to determine the most affordable plan that meets your employee needs. Items to Consider: Size of network Pharmacy plan coverage Audit of dependents on plan Employee Health Insurance Review the potential benefits of self insurance if your claims li are under control. Mk Make sure that your stop loss policy is set at limits you can afford if claims rise. Self insurance avoids ACA taxes of almost 7% as of January 1, Offer wellness incentives to employees and families to avoid chronic problems. 39

40 Controlling Insurance Costs Key question: Does your broker really work hard dfor you each year? Renewals of professional, property, D&O and general liability policies: Is this coverage just rolled over each year or are all active markets pursued on a regular basis? Ask the broker for ideas to control premiums. Controlling Insurance Costs Have you compared policy costs under various deductible levels? Use annual brokerage fees rather than straight commissions to reward broker performance! Why should they get paid more simply if premiums rise? Be aware of new program offerings like Cb Cyber Insurance.. 40

41 Workers Compensation Maintain a safety committee to reduce losses. Use light duty assignments for earlier return to work. Make sure your employees are in the proper risk group: clinical, office, HHA. Meet quarterly to review claims. Review the potential of self insurance with group captives. Reducing Costs of Office Space Investigate potential renegotiation of lease even if that extends the length of the lease. Pursue sub leasing of excess space if permitted in your lease. Negotiate with Landlord caps in charges for overhead, maintenance fees, utilities, etc. End of lease approaching: Should we relocate? Analyze: Buy vs. Lease/ Move vs. Stay 41

42 Reducing Costs of Office Space Be aware of decreasing need for space: Reduced medical supply storage space Clinicians syncing devices through internet connections means less shared space. Is the Chart Room still needed with electronic patient charts? Potential for staff sharing offices Consolidate meeting areas Cost Report Preparation Benefit analysis: Internal vs. Outsourced Need Appropriate Reporting and Records Tracked throughout the year Precise cost centers revenue tracking visit tracking, levels of care for hospice, supplies Cost Reports are a Key Component in Future Cost Reports are a Key Component in Future Rebasing your cost report will effect not only your agency, but the whole industry. 42

43 Information System Cost Controls Be aggressive in your contract negotiations. Ask for multiple year renewals with no increase in annual maintenance charges. Why should you incur inflationary increases if CMS doesn t give it to you? Ask for a price break with each new purchase. Are you using all of the systems you paid for? Information System Cost Controls Be aware of competitors pricing and use it to get concessions. Be aware of new technology and the implications for your agency: for example, using an outside fax server to send referral information electronically to field staff. Look kto implement paperless systems to save paper and storage costs. They also add to efficiency. 43

44 Telephone Costs Analyze you phone bills and seek competitive bids on the services you need: regular and long distance, cell phones, internet and wireless cards. Use volume and competition to get discounts. Analyze your T 1 line traffic to right size your capacity and pay only for what you need. Are you using everything you are paying for? Control your costs: Banking Costs Do you need all of the bank accounts you have? Do you need to use multiple banks? Do you wire funds instead of using ACH s? Do you mandate direct deposit for your employees? Does the bank automate reconciliations? 44

45 Banking Costs Know how your bank charges you and when charges are changed. Frequent automated sweeps to investment accounts from checking may not be worth the low interest earned. Earnings credits exceedinterest income. Maintain good internal controls over check signing requirements and fund transfers. Banking Costs Project your cashflows!!! Make sure they are accurate by comparing forecast tto actual each month. Share results with the bank. Anticipate your borrowing needs early and give them adequate time for approval of loans. This will allow time to get best deal. 45

46 Marketing costs Use benchmarks to monitor overall costs. Understand dhow your market ktinfluences need for additional marketing costs. Use a CRM software system to monitor outside sales activities and contacts. Assign territories and accounts to each marketer to avoid confusion over who gets credit for the referral. Marketing costs Purchase Medicare market share information each year in order to determine dt if competitors are stealing your business. Know reasons for incurring more costs and develop tools to measure effectiveness of these new items. Monitor each marketers effectiveness in producing admitted Medicare referrals. 46

47 Reducing Bad Debts Know where your Bad Debts come from: Lack of assertive collection staff Timely Filing requirements must be met. Proper authorizations upfront Notice to patients of co pays required Continuing to acceptpayers payers that won t pay Face to Face Encounters that never occur Contracts signed with new payers Margin Focus By definition, Gross Margin is the difference between revenue and direct costs for an agency. It is important to look at your revenue streams first and then understand profitability by payer source. Medicare/PPS payers Non Medicare 47

48 Margin Focus On the cost side, the ease of calculating your cost per visit depends upon your pay structure Pay per visit model Hourly Fixed salary Margin Focus Average Cost per Visit $90 $ Medicare Non Medicare 48

49 Margin Focus Average Gross Profit Margin % 56% 60% 50% 40% 30% 20% 10% 0% 28% Medicare Non Medicare Margin Focus Payer Mix % 86% 100% 57% 80% 60% 40% 20% 0% Jul Client Census Jun Jul 13 Jun With a 5% decrease in census from July 2013 to June 2014, we had a 29% increase in payer mix. Although we gave up census in the short term for higher margins, within a year we have rebuilt our census to 95% of what it was a year ago, with much higher margins. 49

50 Capacity, Utilization and Productivity Choose a pay model that works for your agency Use industry benchmarks to set clear expectations on the front end Implement a tool to monitor expectations. Provide results to Clinical Management so they can hold field staff accountable. Understand your capacity and do not put yourself in a position where you are unable to take a referral. Utilization and Productivity Utilization % 100% 71% 88% 80% 60% 40% 20% 0% Jul 13 Jun 14 Productivity % 100% 100% 98% 96% 94% 92% 90% 88% Jul 13 93% Jun 14 50

51 Cell Phones and Air Cards Know both the costs and functionality of your mobile devices: Appropriate device Does one clinician require both an air card as well as a cell phone? Can one device double as both? Appropriate plan Does your carrier allow you to have a shared data pool? Management of Indirect Costs Know appropriate staffing levels for your agency You should ldknow when it is appropriate it to add or eliminate positions: Intake Authorizations Coordinator Scheduler Clinical Management Medical Records Source: McBee Associates, Inc. benchmarking data 51

52 Management of Indirect Costs Intake referrals per day for referral entry into system from start to finish. Authorizations Coordinator Most cases, which require authorization, need to be worked once per week and an FTE should be able to work about cases per day. Source: McBee Associates, Inc. benchmarking data Management of Indirect Costs Scheduler patients t per scheduler Source: McBee Associates, Inc. benchmarking data 52

53 Management of Indirect Costs Clinical Management Baseline of patients per clinical manager caseload. Mdi Medical lrecords Baseline of 120 document touches per day per medical records staff. Source: McBee Associates, Inc. benchmarking data Management of Indirect Costs Medical Records: It has never been more important to ensure compliance and completeness of documentation Key topics for consideration: Make sure that your agency has appropriate mechanisms in place to ensure that claims are billable and collectible. Make sure that there is collaboration between the revenue cycle manager and Operations. It is recommended that routine reporting be doneto monitor outstanding documentation. 53

54 Management of Indirect Costs In 2012, our agency made the decision to combine the responsibility ofhome Health and Hospice under one Executive Director. This concept has run its course for our agency. Agencies must be agile. Given the dynamic nature of our industry what worked two years ago may not work today. Management of Indirect Costs Consider outsourcing OASIS coding and review We outsourced dthis function approximately 18 months ago. At the time we outsourced coding and review our average days to lock an OASIS was 30; today our average is 8. Information Technology Outsourcing IT support to a competent Managed Services Provider (MSP) can mean lower overall technology costs for your company Payroll There are several options to be considered for payroll outsourcing 54

55 Management of Indirect Costs Determine appropriate staffing levels for your agency Information Technology Accounting Billing Human Resources Payroll Ideas for cost savings in Selling, General & Administrative Accounting: Identify redundancies and job overlap Billing: Review processes; ensure that you have automated everything that you can. Remit all claims electronically and only accept electronic payments. Human Resources: Ensure that you are y utilizing your insurance broker at their maximum potential. 55

56 Questions? Andrea Devoti David Berman Rob Simione Walt Borginis org Walt Borginis Shawn Ricketts THANK YOU! 56